Provider Demographics
NPI:1033424585
Name:BRENDA LEE CASEY, LLC
Entity Type:Organization
Organization Name:BRENDA LEE CASEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:636-484-2733
Mailing Address - Street 1:106 FOUR SEASONS SHOPPING CTR
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3173
Mailing Address - Country:US
Mailing Address - Phone:636-484-2733
Mailing Address - Fax:314-392-9558
Practice Address - Street 1:106 FOUR SEASONS SHOPPING CTR
Practice Address - Street 2:SUITE 103B
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3173
Practice Address - Country:US
Practice Address - Phone:636-484-2733
Practice Address - Fax:314-392-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002029846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497394809Medicaid